Throwing the baby out with the bath water — response to the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report on traumatic shaking

Excerpt

The recent publication by Lynøe et al. [1] provides an opportunity to debate the diagnosis of abusive head trauma in scientific journals instead of behind the (often closed) doors of the courtroom. The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) report [2] casts doubt on the quality of the evidence of shaken baby syndrome, is cited in the French Wikipedia and has already been cited in court. The new report raises major medical concern because it may already have disrupted efforts to protect vulnerable children. Shaking is repeated in more than half of reported cases of abusive head trauma, and more than one child in the same family or household may be injured by the same perpetrator(s) in these cases. Recent efforts to cast unwarranted doubt on the medical fact that the diagnostic triad (subdural hematoma, cerebral edema and retinal hemorrhages) can reliably be associated with abusive head trauma may have catastrophic consequences. It should be noted that in contrast to the inexplicably narrow focus of the SBU panel, pediatric radiologists consider shaking as a possible — but not the only — form of physical abuse. As physicians, we do not diagnose shaking, we diagnose abuse. Neither do we diagnose the triad — which is a lawyer-created name for a constellation of medical findings that may have multiple generally possible causes but that in any specific case helps physicians who treat and diagnose infants and children to determine the most medically plausible explanation for head trauma injuries. …